Healthcare Provider Details

I. General information

NPI: 1598713448
Provider Name (Legal Business Name): SCOTT JOHN SCHOENHERR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 PANTHERSVILLE ROAD PATIENT ACCOUNTS OFFICE
DECATUR GA
30034-3828
US

IV. Provider business mailing address

P O BOX 370407 PATIENT ACCOUNTS OFFICE
DECATUR GA
30034-3828
US

V. Phone/Fax

Practice location:
  • Phone: 404-243-2100
  • Fax: 404-243-2159
Mailing address:
  • Phone: 404-243-2100
  • Fax: 404-243-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY001939
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: